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No one knows exactly what drives these impulses for
self-destruction, and in many ways,
suicide remains a difficult problem to solve. But despite the
impression that suicide is inevitable, it's anything but. In
fact, the knowledge needed to prevent many suicides already
exists, researchers say. It's just a matter of reaching those who
need it most.

"If we really cared about depression as a society, we could make
a huge difference," said Adam Kaplin, a psychiatrist and suicide
expert at Johns Hopkins Hospital in Baltimore. [ 5
Myths About Suicide, Debunked ]

The efforts needed include identifying those at risk, removing
their means of suicide and providing access to help, an effort
that increasingly relies on technology to meet people where they
are.

Suicide rises

In 2010, suicide slipped into
the top 10 causes of all deaths in the United States. Among
10- to 14-year-olds and 15- to 24-year-olds, suicide was the
third-most common cause of death. For 25- to 34-year-olds, it was
the second.

Those data corresponded to increases in military suicides as well
as increases in teen suicides and a
steady climb in suicides of people ages 45 to 64. Rates are
highest in the " suicide
belt " of the American West and lowest in the Northeast.

The demographics of suicide paint a portrait of those most at
risk: white men over 60 with access to firearms. Self-inflicted
shootings are the method of half of completed suicides, according
to the most recent Centers for Disease Control and Prevention
(CDC) data. For reasons no one fully understands, Kaplin told
Live Science, African- American women are the least likely of any
demographic group to commit suicide.

There are other mysteries about self-inflicted deaths: Around the
world, they tend to peak
in spring, for example. But perhaps the most frustrating is
the mystery of why some people become suicidal in the first
place. [ Suicide:
Red Flags and How to Help ]

"Suicides, by and large, are very impulsive behaviors," said Dr.
C. Edward Coffey, the CEO of behavioral health at Henry Ford
Hospital in Detroit. "Patients will tell you, 'The notion is
always in the back of my mind, it's kind of always there, but
most of the time it's not very strong and I don't pay it any
attention.' But every now and then, that notion can bubble up to
the top."

The vast majority — 90 percent or more — of people who are
suicidal have a diagnosable mental illness, often depression. But
predicting whether any given person with depression, bipolar
disorder or another mental illness will
commit suicide is difficult. Suicide may be all too common,
but it's also relatively rare: In 2010, about 38,000 people out
of a U.S. population of about 308 million committed suicide.

"Anything with that low a base rate is tough [to predict]," said
Thomas Joiner, a psychologist at Florida State University and the
author of "Why People Die By Suicide" (Harvard University Press,
2005).

Stopping stigma and secrecy

The stigma surrounding suicide can sometimes stymie treatment.
It's hard to hear a friend or relative discuss wanting to kill
themselves or talk about wanting to end their pain. But in 50
percent to 75 percent of cases, people who attempt suicide signal
their intentions beforehand, according to the American Foundation
for Suicide Prevention. Taking these signals seriously can help.
[ 10
Stigmatized Health Disorders ]

Researchers are now working on ways to make reaching out easier.

Scottye Cash, a professor of social work at The Ohio State
University, has found that
troubled adolescents often make their pain known on social
networking sites. One analysis, published in the journal
Cyberpsychology, Behavior and Social Networking in 2013, found
heart-wrenching missives related to suicide posted on MySpace.
"[H]ey yeah well right know about this seconde [sic] I want to
die," read one representative comment. "Just want to not be here
any more."

This use of technology has researchers who work with teens
focusing on ways to find young people who are struggling.
Nonprofit Reach Out has a website with forums and a weekly text
line. Crisis Text Line provides free, 24-hour-a-day help for
teenagers in crisis.

"We know that adolescents typically don't even disclose stuff to
health care providers," Cash told Live Science. Many find it
easier to text than talk, she said. Studies in physicians'
offices have found that teens also disclose their feelings more
freely if given a questionnaire on a tablet rather than being
asked by a nurse, she said.

Similar efforts are being made for adults. Johns Hopkins' Kaplin
has invented a text-message based program that pings people every
day and asks them their mood. They text back, and the information
can be shared with doctors, family or friends. This
moment-to-moment measurement enables doctors to see if treatments
are working, or if a person is headed toward a crisis, Kaplin
said.

Meanwhile, Mental Health of America, Texas, has created an app
called "Hope Box," which allows users to make virtual scrapbooks
of mood-lifters, such as pictures of loved ones, to have on hand
if their mood spirals downward. The idea is to buy time and pull
people out of the mental health crisis that precedes suicide,
Joiner said.

"The theme cutting across studies is that there are precursors to
suicide attempts and to deaths by suicide that are pretty
identifiable and pretty modifiable," Joiner said.

Revamping medicine

The effectiveness of virtual outreach still needs to be tested.
But the Henry Ford Hospital of Detroit offers a glimpse of what
is possible, if suicidal people get the help they need.

In 2001, the hospital's behavioral health center won a grant from
the Robert Wood Johnson Foundation as part of a larger initiative
dubbed "Pursuing Perfection." Henry Ford's staff wanted to pursue
perfect
depression care, Coffey said. As the team discussed what
perfect care would look like, one of the nurses suggested if they
conducted perfect depression care, maybe no one would kill
themselves.

"When she made the statement, our room went absolutely dead
still," Coffey said. "No one said anything for several minutes."

A senior staffer broke the silence to say the goal was
impossible. Suicide was inevitable — wasn't it?

But the goal was set.

"There has almost been in the field kind of a resignation that
there is going to be a certain level of suicide, no matter what
you do," Coffey said. "And we basically decided not to accept
that premise."

Tackling such a major goal meant a reorganization of everything
the clinic did. Knowing that a reduction of a few percentage
points wasn't enough meant the hospital had to re-evaluate
everything. One major change was in the way the staff talked
about weapons with patients. Before launching the perfect care
program, doctors might ask a suicidal patient once if he or she
had access to firearms, which are a
highly lethal method of suicide.

But once the program started, those conversations became more
in-depth. First, the doctors would ask their patients and their
families about weapons. If they said there were none in the home,
"We'd say, 'Okay, great, but your homework is to go back, sweep
the house and you've got to call me tonight,'" Coffey said.
Often, the families would call back, shocked to report that an
old shotgun had been found in the attic or that there were
pistols stashed in forgotten places, he said.

Doctors would talk to suicidal patients about how they envisioned
dying. Contrary to conventional wisdom, these discussions don't
put thoughts in
suicidal people's heads. Instead, they gave doctors ways to
throw up roadblocks to the plans. If someone mentioned hanging
themselves, for example, they'd be told to get the rope out of
the house. The more barriers a person has to overcome, the harder
it is for them to act on the suicidal impulse, Coffey said.

Another major change was making diagnosis and access to care
easier. Most people who commit
suicide have seen a doctor in the year before their deaths,
Coffey said. But few are diagnosed with the mental disorder that
will eventually kill them.

"We don't need an intellectual breakthrough, necessarily," Coffey
said. "We know there are things to do better on the delivery
side."

The efforts paid off. In 2000, before the program started, the
suicide rate among Henry Ford's managed-care population was 89
out of 100,000 people. At start-up in 2001, that dropped to 77
out of 100,000. By the time the program was fully implemented
between 2002 and 2005, the rate went down to 22 per 100,000.

"We lowered the rate by 80 percent," Coffey said. "Unheard of."

There have even been a few years, he said, when not a single
patient has died by suicide.